The European Particle Therapy Network (EPTN) consensus on the follow-up of adult patients with brain and skull base tumours treated with photon or proton irradiation

Radiother Oncol. 2022 Mar:168:241-249. doi: 10.1016/j.radonc.2022.01.018. Epub 2022 Jan 29.


Purpose: Treatment-related toxicity after irradiation of brain tumours has been underreported in the literature. Furthermore, there is considerable heterogeneity on how and when toxicity is evaluated. The aim of this European Particle Network (EPTN) collaborative project is to develop recommendations for uniform follow-up and toxicity scoring of adult brain tumour patients treated with radiotherapy.

Methods: A Delphi method-based consensus was reached among 24 international radiation-oncology experts in the field of neuro-oncology concerning the toxicity endpoints, evaluation methods and time points.

Results: In this paper, we present a basic framework for consistent toxicity scoring and follow-up, using multiple levels of recommendation. Level I includes all recommendations that are considered minimum of care, whereas level II and III are optional evaluations in the advanced clinical or research setting, respectively. Per outcome domain, the clinical endpoints and evaluation methods per level are listed. Where relevant, the organ at risk threshold doses for recommended referral to specific organ specialists are defined.

Conclusion: These consensus-based recommendations for follow-up will enable the collection of uniform toxicity data of brain tumour patients treated with radiotherapy. With adoptation of this standard, collaboration will be facilitated and we can further propel the research field of radiation-induced toxicities relevant for these patients. An online tool to implement this guideline in clinical practice is provided at

Keywords: Brain tumour; Central nervous system; European Particle Therapy Network; Follow-up; Particle therapy; Skull base tumour; Toxicity.

Publication types

  • Review

MeSH terms

  • Adult
  • Brain
  • Consensus
  • Follow-Up Studies
  • Humans
  • Proton Therapy* / adverse effects
  • Protons
  • Skull Base Neoplasms* / radiotherapy


  • Protons